ABSTRACT
Thromboangiitis obliterans (TAO) is often cited as an extreme phenotype of vasculopathy and tobacco dependence. Although tobacco exposure is essential to progression of arterial ischemia in TAO, expert opinion differs regarding the degree of tobacco dependence in this population. The authors designed a prospective, case-control study to test the hypothesis that subjects with TAO have a greater degree of tobacco dependence than control subjects with coronary atherosclerosis (coronary artery disease [CAD]) do. Subjects with TAO (n = 218, confirmed by angiography, biopsy, or noninvasive arterial testing) or CAD (n = 343, diagnosed by coronary angiography) were mailed a standardized questionnaire regarding tobacco use, to which 103 and 273 responded, respectively. The degree of tobacco dependence in each group was ascertained by several methods, including the Fagerström Test for Nicotine Dependence Questionnaire. The TAO group was younger at index date (year of first diagnosis for TAO patients, year of percutaneous transluminal coronary angioplasty [PTCA] for CAD patients) (TAO 37.6+/-9.0 vs CAD 43.3+/-4.9 yr, p < 0.0001), but the groups did not differ in age at first tobacco exposure (TAO 16.7+/-3.1 vs CAD 17.3+/-4.2 yr, p = 0.67), current tobacco use at time of survey (TAO 54% vs CAD 46%, p = 0.17), or Fagerström score (TAO 4.7+/-2.3 vs CAD 5.1+/-2.3, p = 0.24). Kaplan-Meier curves showed no significant difference in time to topping tobacco use after first diagnosis (p = 0.076). TAO subjects smoked fewer cigarettes per day than CAD subjects (TAO 22.3+/-10.7 vs CAD 27.7+/-15.3 cigarettes/day, p = 0.003). Among current smokers (n = 170), TAO subjects also smoked fewer cigarettes/day (20.2+/-8.2 vs 24.6+/-12.7, p = 0.03), and were more likely to have made a serious attempt to stop (97% vs 90%, p = 0.03). In contrast to case reports of extreme tobacco dependence in the TAO population, the degree of tobacco dependence in subjects with TAO is similar to that in subjects with CAD.
Subject(s)
Thromboangiitis Obliterans/etiology , Tobacco Use Disorder/complications , Adult , Angiography , Biopsy , Case-Control Studies , Coronary Artery Disease/complications , Coronary Artery Disease/epidemiology , Female , Humans , Incidence , Male , Middle Aged , Prospective Studies , Risk Factors , Surveys and Questionnaires , Thromboangiitis Obliterans/diagnosis , Tobacco Use Disorder/epidemiologyABSTRACT
BACKGROUND: Cytosine-adenine-guanine repeat length of the androgen receptor gene and the A49T and V89L polymorphisms of the 5 alpha-reductase (SRD5A2) gene have been associated with prostate cancer. METHODS: We investigated the relationship of the three genetic polymorphisms to tumor grade among 211 men who had undergone radical prostatectomy. Subjects had prostate cancer <3 cm(3) with a percentage of cancer represented by Gleason grade 4 or 5 (% Gleason grade 4/5) of either > or = 20% or < or = 5%. We also examined the association between those genetic markers and prostate specific antigen (PSA) failure among 112 subjects with > or = 20% Gleason grade 4/5. RESULTS: In cross-sectional analysis, none of the polymorphisms was a significant predictor of % Gleason grade 4/5. In longitudinal analysis, the LL genotype at the V89L site was associated with statistically significant four- to sixfold increase in PSA failure risk after adjustment for clinicopathologic variables. CONCLUSIONS: We observed poorer prognosis among men with the LL genotype at codon 89 of the SRD5A2 gene. Lack of consistency between studies must be resolved before clinical utility of this marker is established.
